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400 BC
ON HEMORRHOIDS
by Hippocrates
translated by Francis Adams
The disease of the hemorrhoids is formed in this way： if bile or
phlegm be determined to the veins in the rectum； it heats the blood in
the veins； and these veins becoming heated attract blood from the
nearest veins； and being gorged the inside of the gut swells
outwardly； and the heads of the veins are raised up； and being at
the same time bruised by the faeces passing out； and injured by the
blood collected in them； they squirt out blood； most frequently
along with the faeces； but sometimes without faeces。 It is to be cured
thus：
2。 In the first place it should be known in what sort of a place
they are formed。 For cutting； excising； sewing； binding； applying
putrefacient means to the anus；…all these appear to be very formidable
things； and yet； after all； they are not attended with mischief。 I
recommend seven or eight small pieces of iron to be prepared； a fathom
in size； in thickness like a thick specillum； and bent at the
extremity； and a broad piece should be on the extremity； like a
small obolus。 Having on the preceding day first purged the man with
medicine； on the day of the operation apply the cautery。 Having laid
him on his back； and placed a pillow below the breech； force out the
anus as much as possible with the fingers； and make the irons red…hot；
and burn the pile until it be dried up； and so as that no part may
be left behind。 And burn so as to leave none of the hemorrhoids
unburnt； for you should burn them all up。 You will recognize the
hemorrhoids without difficulty； for they project on the inside of
the gut like dark…colored grapes； and when the anus is forced out they
spurt blood。 When the cautery is applied the patient's head and
hands should be held so that he may not stir； but he himself should
cry out； for this will make the rectum project the more。 When you have
performed the burning； boil lentils and tares； finely triturated in
water； and apply as a cataplasm for five or six days。 But on the
seventh； cut a soft sponge into a very slender slice； its width should
be about six inches square。 Then a thin smooth piece of cloth； of
the same size as the sponge； is to be smeared with honey and
applied； and with the index finger of the left hand the middle of
the sponge is to be pushed as far up as possible； and afterward wool
is to be placed upon the sponge so that it may remain in the anus。 And
having girded the patient about the loins and fastened a shawl to
the girdle； bring up this band from behind between the legs and attach
it to the girdle at the navel。 Then let the medicine which I
formerly said is calculated to render the skin thick and strong； be
bound on。 These things should be kept on for not less than twenty
days。 The patient should once a day take a draught from flour or
millet； or bran； and drink water。 When the patient goes to stool the
part should be washed with hot water。 Every third day he should take
the bath。
3。 Another method of cure：…Having got the anus to protrude as much
as possible； foment with hot water； and then cut off the extremities
of the hemorrhoids。 But this medicine should be prepared beforehand；
as an application to the wound：…Having put urine into a bronze vessel；
sprinkle upon the urine the flower of bronze calcined and finely
triturated； then； when it is moistened； shake the vessel and dry in
the sun。 When it becomes dry； let it be scraped down and levigated；
and apply with the finger to the part； and having oiled compresses；
apply them； and bind a sponge above。
4。 Another method：…There grows upon the bleeding condyloma； a
protuberance like the fruit of the mulberry； and if the condyloma be
far without； an envelope of flesh is adherent to it。 Having placed the
man over two round stones upon his knees； examine； for you will find
the parts near the anus between the buttocks inflated； and blood
proceeding from within。 If； then； the condyloma below the cover be
of a soft nature； bring it away with the finger； for there is no
more difficulty in this than in skinning a sheep； to pass the finger
between the hide and the flesh。 And this should be accomplished
without the patient's knowledge； while he is kept in conversation。
When the condyloma is taken off； streaks of blood necessarily flow
from the whole of the torn part。 It must be speedily washed with a
decoction of galls； in a dry wine； and the bleeding vein will
disappear along with the condyloma； and its cover will be replaced。
The older it is； the more easy the cure。
5。 But if the condyloma be higher up； you must examine it with the
speculum； and you should take care not to be deceived by the speculum；
for when expanded； it renders the condyloma level with the surrounding
parts； but when contracted； it shows the tumor right again。 It is to
be removed by smearing it with black hellebore on the finger。 Then； on
the third day； wash it out with a dry wine。 You need not be
surprised that there is no discharge of blood when you remove the
condyloma； for neither； if you cut off the hands or legs at the
articulations will there be any flow of blood； but if you cut them off
above or below the joints； you will find there hollow veins which pour
out blood； and you will have difficulty in stopping the bleeding。 In
the same manner； the bleeding vein in the anus； if you cut it above or
below the point of separation of the condyloma； will pour forth blood；
but if you take away the condyloma at its junction （with the natural
parts？） there will be no flow of blood。 If matters then be thus put to
rights； it will be well； but otherwise burn it； taking care not to
touch the place with the iron； but bringing it close so as to dry it
up； and apply the flos aeris in the urine。
6。 Another method of curing hemorrhoids：…You must prepare a
cautery like the arundo phragmites； and an iron that exactly fits is
to be adapted to it； then the tube being introduced into the anus； the
iron； red hot； is to be passed down it； and frequently drawn out； so
that the part may bear the more heat； and no sore may result from
the heating； and the dried veins may heal up。 But if you are neither
disposed to burn nor excise； having first fomented with plenty hot
water and turned out the anus； levigate myrrh； and having burnt
galls and Egyptian alum； in the proportion of one and a half to the
other things； and as much of melanteria； these things are all to be
used in a dry state。 The hemorrhoid will separate under the use of
these medicines； like a piece of burnt hide。 You are to proceed thus
until the whole are removed； and a half part of burnt chalcitis does
the same thing。 But if you wish to effect the cure by suppositories；
take the shell of the part fish a third part of plumbago； bitumen；
alum； a little of the flos aeris； galls； a little verdigris； having
poured a small quantity of boiled honey on these； and formed an oblong
suppository； apply until you remove them。
7。 An hemorrhoid in a woman may be thus cured。 Having fomented
with plenty of hot water； boil in the water certain of the fragrant
medicines； add pounded tamarisk； roasted litharge and galls； and
pour on them white wine； and oil； and the grease of a goose；
pounding all together。 Give to use after fomenting。 In fomenting the
anus is to be made to protrude as much as possible。
THE END